ET-4943
Brochure Active Employee / Retiree / Other Benefit Recipient

Administrative Appeal Process

This brochure is designed to assist you in understanding the administrative appeals process as it relates to ETF. It is not intended to substitute for the legal advice or assistance of an attorney.

State Maintenance Plan (SMP) by Dean Health Plan for Locals

Major Health Systems
  • Aspirus Health
  • Ascension Wisconsin
  • Aurora Health Care
  • Essentia Health
  • Marshfield Clinic
  • Northlakes Community Clinics
  • St. Luke's (Aspirus Health)
Full Service Areas
  • Adams County
  • Ashland County
  • Barron County
  • Bayfield County
  • Buffalo County
  • Burnett County
  • Clark County
  • Columbia County
  • Douglas County
  • Dunn County
  • Florence County
  • Forest County
  • Grant County
  • Green County
  • Iowa County
  • Iron County
  • Jefferson County
  • Juneau County
  • Lafayette County
  • Langlade County
  • Lincoln County
  • Marathon County
  • Marquette County
  • Menominee County
  • Oneida County
  • Polk County
  • Portage County
  • Price County
  • Richland County
  • Rock County
  • Rusk County
  • Sauk County
  • Sawyer County
  • St. Croix County
  • Taylor County
  • Vilas County
  • Walworth County
  • Washburn County
  • Wood County
Limited Service Areas
  • Michigan
  • Minnesota
ET-2572
Form Local Employer / State Employer

New Employee Benefit Checklist

A tool for an employer to confirm information was presented to a new employee, due dates identified and appropriate information and forms supplied for all ETF-administered benefits offered by the employer.

Quartz - UW Health

Major Health Systems
  • Access Community Health Centers
  • Associated Physicians, LLP
  • Madison Women's Health, LLP
  • Physicians for Women
  • UnityPoint Health – Meriter Hospital & Clinics
  • UW Health Hospitals & Clinics
  • Wildwood Family Clinic, SC
Full Service Areas
  • Dane County
ET-2305
Form Active Employee / Local Employer / State Employer

Evidence of Insurability

Employees who did not enroll for group life insurance coverage during their initial enrollment period, or insured employees who wish to apply for more insurance for themselves or their spouse or dependents, may apply using this form.